Hip anatomy/biomechanics
What are the intracapsular ligaments?
Ligamentum teres: attaches to the acetabular notch to the fovea capitis, taut in adduction, flexion and ER
Transverse Acetabular Ligament: straddles bottom part of labrum, turns acetbular notch into a foramen for vessels to pass through
What is normal for angle of inclination? What would indicate coxa vara/coxa valga- how do these angles affect movement at the hip?
125 degrees normal
<125 coxa vara: increased hip stability, decreased mobility
>125 coxa valga: increased hip mobility, decreased stability
If a patient came in with pain in their right lower abdomen and they have had symptoms of nausea and vomiting, what pathology should you rule out? What is a test/sign would be positive?
Appendicitis
+ McBurney's point
A 77 year old female fell down her stairs and is coming into the ER. She has sharp pain in her hip and groin area that hurts whenever she moves her leg. What pathology might we suspect?
A. Septic hip arthritis
B. Femoral acetabular impingement
C. Femoral neck fracture
D. Greater trochanteric pain syndrome
C. Femoral neck fracture
What ICF category is piriformis syndrome and lateral femoral cutaneous neuropathy associated with?
Hip pain with radiating leg pain
What are the extracapsular ligaments? What motions do they resist?
Iliofemoral ligament (Y ligament): resists extension, adduction (STRONGEST LIGAMENT IN BODY)
Pubofemoral ligament: resists hip abduction and extension
Ischiofemoral ligament: reinforces the capsule posteriorly, resists excessive extension and IR of the hip
What is the normal angle of torsion at the hip? What would indicate anteversion/retroversion?
Normal: 10-20 degrees
Anteversion: >15-20 degrees (Increased IR, Decreased ER)
Retroversion: <15-20 degrees (Decreased IR, Increased ER)
If a patient had pain in their groin area and their pain was worsened by coughing and sneezing what pathology could you suspect?
Inguinal hernia
A 45 year old patient is coming into the clinic and they will not walk on their leg because it hurts too much. They were diagnosed with strep throat a week and a half ago but have been on antibiotics since then. What pathology might we suspect?
A. Avascular necrosis
B. Septic Hip Arthritis
C. Slipped Capital Femoral Epiphysis
D. Femoral Acetabular Impingement
B. Septic Hip Arthritis
What are the 3 things you can do to assess for a muscle strain?
Palpate the muscle
Stretch the muscle
Apply resistance to the muscle
What does the sciatic nerve split into?
Common peroneal (fibular) and tibial nerve
What is the most common cause of hip pain in older adults?
OA
A 5 year old boy complains of groin pain that is worse with hip movement especially in IR and Abduction, he also walks with an abnormal gait. What pathology might we suspect?
Legg-calve-perthes disease
What ICF category is hip flexor strain, adductor strain, hamstring strain, greater trochanteric pain syndrome and IT band syndrome associated with?
Hip pain with muscle power deficits
What are the different presentations of the levels of muscle strains?
Strong and pain free--> muscle intact
Slightly less strong and painful --> 1st or 2nd degree strain (low level)
Weak and painful --> 2nd degree (more severe strain)
Weak and pain FREE --> 3rd degree (rupture or nerve root involvement)
What are the borders of the femoral triangle? What is in the femoral triangle?
Superior: inguinal ligament
Medial: adductor longus
Lateral: sartorius
femoral nerve --> femoral artery --> femoral vein --> lymphatics
What score on the WOMAC is good/bad?
Low scores= good
High scores=bad (indicates worse pain, stiffness, and functional limitation)
What history would a patient with osteonecrosis of the femoral head (avascular necrosis) present with? What would we find in an exam?
Hx: history of long term corticosteroid use (RA, asthma), history of AVN in the other hip, history of trauma
Exam: gradual onset of pain, may refer to groin, thigh or medial knee, worse with weight bearing, restrictions in flexion, IR and adduction
What ICF category is hip OA associated with?
Hip pain with mobility deficits
How long does it take for muscle strains to recover?
up to 6 weeks depending on the grade severity
What is the open packed position of the hip? Why is this important?
10-30 degrees of flexion, 10-30 degrees of abduction and 0-5 degrees of ER
Important for manipulation purposes
What indicates a good/bad score on the LEFS?
High score= good (indicates higher function)
Low score=bad
A 13 year old patient comes in who is overweight and is having groin pain that is worse with weight bearing and their leg is in a more externally rotated position . What pathology might you suspect?
A. Femoral neck fracture
B. Slipped Capital Femoral Epiphysis
C. Septic Hip Arthritis
D. Avascular necrosis
B. Slipped Capital Femoral Epiphysis
What ICF category is labral tear and femoral acetabular impingement associated with?
Hip pain with coordination deficits
What causes IT band syndrome? Who is most at risk?
Caused by excessive friction between the lateral femoral epicondyle and the IT tract
At risk: repetitive knee flexion/extension movements (runners and cyclists)